injury rehab

Poke the bear. (But don’t hump the s%it out of the bear.

I’ll get to the above statement in a moment. (Mom, I apologize but blame Greg for it. I’m just quoting what he said.)

I recently attended Reconciling Biomechanics with Pain Science, a two-day seminar with chiropractor and physiotherapist. Greg Lehman. (There aren’t too many people schooled in both disciplines.) The course was superb! I recommend the course to anyone involved in helping people move and get out of pain, whether you’re a trainer, coach, massage therapist, chiropractor, physical therapist, etc.

This is the cutting edge of pain science. The information may challenge what you hold near and dear as pain gospel, most importantly, pain doesn’t always equal damage. Nor should painful movements always be avoided. In fact, engaging in painful movement is part of getting past the pain and back to living.

This was another big dose of information with which I was familiar. Much like reading a book for the second, third, or 19th time, it’s always useful to revisit and re-examine important information. I came away with a deeper understanding of how pain works and how to work with it.

I’ll discuss what I learned and how I’ll apply this information to over the next several blog posts. Here’s my first takeaway:

You’re free to poke into pain

One of the best ways to overcome pain, regain function, and have fun doing what you love is to load the affected area. Does something hurt when you move it? If so, do the movement slowly and safely to the edge of your ability. Add a little more work over time. Work to the level of pain that you can tolerate. Load the movement to your tolerance. The idea and the expectation is that your tolerance will increase, your pain will decrease, and your life will improve. It may take time, but it’ll happen. This is called graded exposure. Pain is the bear that was mentioned at the top of the post. The concept is that you are free to gradually work to a tolerable level of pain but don’t grind and bash your way into severe pain. You shouldn’t limp, flinch, or recoil from the pain. No white knuckles, please.

If it’s a sore knee, then we’re going to use those parts and make them work. We may do squats, lunges, one-leg squats, hopping—whatever is tolerable. By poking into pain you can habituate to it and decrease the severity. Same with a sore ankle, shoulder, back, etc. Some other examples of pain that diminishes upon exposure:

You sprain your ankle and you “walk it off.” It hurts but you move it, load it, and resume activity to a tolerable level and you’re fine. The ankle might be sore so take it easy but don’t just rest it for days or weeks without using it.

You step into a hot shower and—Wow! It’s hot!—but it feels fine in a few moments. You accomodate. Similarly…

You get into a swimming pool and—Whoooo! It’s chilly!—and you’re fine in a few minutes. You adapt. (Strangely, the same process happens when you step out…)

You start a bike ride or a run and you knee bugs you a little. The pain vanishes in a few minutes. Did you suffer an injury that suddenly healed? No, but you had pain and your nervous system changed and then there was no pain. You’re fine.

Movement is a great way to desensitize the nervous system! Anyone who’s gone through post-surgical rehab for something like an ACL tear (me) has gone through this process. We’ve had to work through a certain amount of pain and discomfort as we progressed out of the injury and back into normal living. The crucial point is this: PAIN DOESN’T EQUAL DAMAGE. You’re not broken.

*****IMPORTANT DISCLAIMER***** I’m not talking about loading an acute, severe injury. If a bone is fractured, if you have a dislocation, if you suspect organ damage or if you’re bleeding then please don’t load it. In this case, you ARE damaged and you need medical help, not a trip to the gym. These conditions should be obvious.

I have vanquished the foe!

In my case, I’ve had some foot and heel pain which has been severe at times. I’ve curtailed my running and I’ve had to face the prospect of missing several big races this year. I’ve spiraled down a drain of negative thoughts and dread. Most runners have faced this overflowing toilet of fear, self-hate, and psychological nastiness. All that stress has only contributed to my pain. What will I do with this crisis? Can life go on???

On the first day of the lecture, I started loading those hurt areas. I sought out the sore spots and made them work. I did both isometric contractions and heel raises with bent and straight knees. I worked various angles and speeds. I worked to the point of local fatigue. My pain started to recede before the lecture was over. My nervous system was changing and my pain was retreating. My hurt spots hurt less.

The next day before the second lecture I went for an easy run. I continued with heel raises and toe work and I added weight to the exercises. My symptoms have only improved. Two days later I did a hard hill workout, a workout that would’ve been seriously painful and nearly unthinkable prior to my new hopeful mindset. I’m not broken! In fact, wouldn’t be surprised if I was made of vibranium… Maybe adamantium. You probably are too!

I’ve had recent discussions with two clients about lingering injuries. The talks brought to mind how my approach to my Achilles tendon pain. I think this new mindset will prove essential to my staying healthy and avoiding future Achilles problems. Maybe it’ll be useful to you.

To be clear, I don’t currently have any Achilles pain. I’m able to run long, sprint, and trail run consistently with no trouble. I want to keep it that way for the rest of eternity and that’s what brought up these thoughts.

Both my clients and I have battled aches and pains in particular regions that have come and gone… and come and gone again over the course of time. Our shared narratives go something like this:

I have pain. I see a physical therapist or chiropractor. He/She prescribes exercises that help. They help. I quit doing said exercises. (Those exercises are BORING as hell. They don’t feel like exercise. They don’t feel like they’re making me stronger, leaner, or more powerful.) Pain comes back at some point. Repeat the process.

Does this chain of events sound familiar?

My aches and pains have caused me to miss training, miss races and forced me out of some of the activities that I enjoy with passion. I’d like to avoid this process, thus I need to do something different from how I’ve done things in the past, otherwise I can expect the same result as before. (We all know about the definition of insanity right?)

I’ve decided that my Achilles tendon is… well… my Achilles heel. It’s my weak spot. For whatever reason, this part of my body is susceptible to problems. Therefore it needs special consideration and care. I’m now motivated to continually do the things that seem to strengthen my Achilles tendon. I want to turn that weak spot into a bulletproof, iron-clad appendage that’s nearly indestructible.

That means almost every day I’m doing standing heel raises. Some days I do high-reps/low-weight. Other days it’s heavy-weight/low-reps. I do bent-knee heel raises and straight-knee heel raises. I do heel raises with a straight foot and with my foot turned in and out. Some days I do lots of heel raises. Some days I do fewer.

My point has less to do with heel raises to cure Achilles problems and more with my behavior and thinking around the problem. The point is that I now constantly tend to this thing that has been a problem for me. I view it as an ongoing project that will never really be complete.

The analogy I’ll make is to that of an addict. Overcoming addiction is an ongoing process. An addict is either getting better or getting worse but he’s never treading water and staying put. An alcoholic/coke addict/sex addict/shopping addict/whatever-addict is an addict forever. Like an addict, it would probably be more enjoyable for me to quit doing my dinky, boring exercises and tell myself that I’m OK. I could easily do whats comfortable and easy.

I could say, “I’m fine. I’m cured. I don’t need to worry about this problem. It’s behind me forever now.”

If I take that tact though I should expect my problem to creep back in, and I hate that thought.

As with almost everything we do in fitness (and everything else in the world) the real target here is the brain, not the injured/painful area. If I want continued success and progress then I must decide to take the appropriate action. If I want a specific outcome (Achilles pain gone forever, weight loss, muscle mass, etc.) then I must adopt the behaviors that will get me there. I need to make new habits. That requires conscious thought and deliberate action. The work won’t do itself.